The The APOPPSAPOPPS™ & ™ & APOPPS-TFAPOPPS-TF™™by by FLO-TECHFLO-TECH®® O&P Systems, Inc. O&P Systems, Inc.

Robert N. Brown, Sr., CPO, FAAOPRobert N. Brown, Sr., CPO, FAAOP

CEO/Research & DesignCEO/Research & Design

Robert N. Brown, Sr., CPO, FAAOPRobert N. Brown, Sr., CPO, FAAOP

CEO/Research & DesignCEO/Research & Design

®

The The APOPPSAPOPPS™ & ™ & APOPPS-TFAPOPPS-TF™ ™ Adjustable Adjustable

Post-Op, Post-Op, Protective & Protective & Preparatory Preparatory System for System for Transtibial & Transtibial & Transfemoral Transfemoral AmputationsAmputations

Design Goals – Keep It Simple:Design Goals – Keep It Simple: S-afe postop systemsS-afe postop systems I-mmediate accessI-mmediate access M-odular socketsM-odular sockets P-rosthetic P-rosthetic

– Function & feelFunction & feel Not “One Size Fits All”Not “One Size Fits All”

L-ook customL-ook custom Not like “Off The Shelf”Not like “Off The Shelf”

E-arly, immediate, training & E-arly, immediate, training & extended ambulation extended ambulation

DELAYED HEALINGDELAYED HEALING Main causeMain cause::

– DiseaseDisease

Chronic causesChronic causes::– DiseaseDisease– Impact injuriesImpact injuries– Microscopic injuries Microscopic injuries

The FLO-TECH-TOR™The FLO-TECH-TOR™ Post-operative, protective or Post-operative, protective or

early fit socket provides:early fit socket provides:– Protection from scraping or impact Protection from scraping or impact

injuriesinjuries– Gentle donning and doffing for easy Gentle donning and doffing for easy

access & attentive wound careaccess & attentive wound care– Control and prevention of flexion Control and prevention of flexion

contracturescontractures– Accommodation for bulbous, conical Accommodation for bulbous, conical

or cylindrical shapesor cylindrical shapes– Monitored early weight bearing & Monitored early weight bearing &

shaping of the residuumshaping of the residuum– Early & training ambulationEarly & training ambulation

When used with a UFOS™ When used with a UFOS™

The The VCSPS™ VCSPS™

Variable Circumference Supra Variable Circumference Supra Patella SocketPatella Socket (PSRD type or (PSRD type or Preparatory socket) provides:Preparatory socket) provides:– Knee flexion mobilityKnee flexion mobility– Gentle donning & doffing for Gentle donning & doffing for

attentive wound careattentive wound care– Early, training & extended Early, training & extended

ambulation ambulation when used with the UFOS™when used with the UFOS™

– Early & controlled shaping of the Early & controlled shaping of the residuumresiduum

– Distal AP closureDistal AP closure– Accommodation for fluctuating Accommodation for fluctuating

volumevolume– IndependenceIndependence

The The UFOS™UFOS™

Universal Frame Outer Socket:Universal Frame Outer Socket:

– Sized to fit and accept either the Sized to fit and accept either the FLO-TECH-TOR™ or VCSPS™FLO-TECH-TOR™ or VCSPS™

Attach the Pylon and footAttach the Pylon and foot

Removed in bedRemoved in bed

Kept in the Physical Therapy Kept in the Physical Therapy DepartmentDepartment

The residuum protected by continued The residuum protected by continued use of the FLO-TECH-TOR™ use of the FLO-TECH-TOR™

The FLO-TECH-TOR-TF™The FLO-TECH-TOR-TF™ Post-operative, protective or Post-operative, protective or

early fit socket provides:early fit socket provides:– Protection from scraping or impact Protection from scraping or impact

injuriesinjuries– Gentle donning and doffing for easy Gentle donning and doffing for easy

access & attentive wound careaccess & attentive wound care– Accommodation for bulbous, conical Accommodation for bulbous, conical

or cylindrical shapesor cylindrical shapes– Distal AP closureDistal AP closure– Monitored early weight bearing & Monitored early weight bearing &

shaping of the residuumshaping of the residuum– Early, training & extended ambulationEarly, training & extended ambulation

When used with a UFOS-TF™ When used with a UFOS-TF™

The UFOS-TF™The UFOS-TF™ Universal Frame Outer Socket:Universal Frame Outer Socket:

– Sized to fit the Sized to fit the FLO-TECH-TOR-TF™FLO-TECH-TOR-TF™

Attach the Knee, Pylon and footAttach the Knee, Pylon and foot

Removed when the patient is in bedRemoved when the patient is in bed

Kept in the Physical Therapy Kept in the Physical Therapy DepartmentDepartment

The residuum protected by continued The residuum protected by continued use of the FLO-TECH-TOR-TF™ use of the FLO-TECH-TOR-TF™

APOPPSAPOPPSTMTM Specifics Specifics Modular socket system for Modular socket system for

transtibial amputations, available in:transtibial amputations, available in:

Lengths of: 5” (child), 7" (youth), Lengths of: 5” (child), 7" (youth), 7” (adult) & 9“ (adult) & custom7” (adult) & 9“ (adult) & custom

Left and RightLeft and Right

102 standard sockets, in 11 sizes102 standard sockets, in 11 sizes

Circumferences 8” to 19” & Circumferences 8” to 19” & customcustom

– Sockets progress in 1” incrementsSockets progress in 1” increments

APOPPS-TFAPOPPS-TF™ Specifics™ Specifics Modular socket system for Modular socket system for

Transfemoral amputations, Transfemoral amputations, available in:available in:– 12" socket length & custom12" socket length & custom– Left & RightLeft & Right– 12 standard sockets in 3 sizes12 standard sockets in 3 sizes– Circumferences 16” to 27” & Circumferences 16” to 27” &

customcustom

Selecting the Proper LengthSelecting the Proper Length

Transtibial SocketsTranstibial Sockets::– MPT to distal end over bandages MPT to distal end over bandages

Transfemoral SocketsTransfemoral Sockets::– Ischium to distal end over bandages Ischium to distal end over bandages

If less than 3/4” space between residuum If less than 3/4” space between residuum and end of socket - SIZE UPand end of socket - SIZE UP

If no stock size available - CUSTOMIf no stock size available - CUSTOM

Selecting the Proper SizeSelecting the Proper Size Transtibial socketsTranstibial sockets::

– Approximately 1 week post-opApproximately 1 week post-op Circumference: 2” to 3” from the distal end Circumference: 2” to 3” from the distal end

– Measure over light bandages & 2 socksMeasure over light bandages & 2 socks– If measured over skin only, add 1”If measured over skin only, add 1”

Length: MPT to distal endLength: MPT to distal end Left or RightLeft or Right

– Prior to amputationPrior to amputation Estimated lengthEstimated length Estimated distal circumferenceEstimated distal circumference

– Add 2“Add 2“ Left or RightLeft or Right

Selecting the Proper SizeSelecting the Proper Size Transfemoral socketsTransfemoral sockets::

– Approximately 1 week post-opApproximately 1 week post-op Ischial Circumference Ischial Circumference

– Measure over light bandages & 2 socksMeasure over light bandages & 2 socks– If measured over skin, add 1”If measured over skin, add 1”

Length: Ischium to distal endLength: Ischium to distal end Left or RightLeft or Right

– Prior to amputationPrior to amputation Estimated lengthEstimated length Ischial circumferenceIschial circumference

– Add 2“Add 2“ Left or RightLeft or Right

One APOPPSOne APOPPS Three Prosthetic Three Prosthetic

Programs:Programs:

#1, #1, The The FLO-TECH-TORFLO-TECH-TOR

– As protective socket onlyAs protective socket only– Prevent and reduce flexion Prevent and reduce flexion

contracturescontractures

– Monitor progress with instant Monitor progress with instant access to bandagesaccess to bandages

– Immediate, early or extended Immediate, early or extended wear protective socketwear protective socket

– Especially good for revision Especially good for revision surgery and to prevent injurysurgery and to prevent injury

One APOPPSOne APOPPS Three Prosthetic Programs:Three Prosthetic Programs:

– #2, #2, The The Rehab SystemRehab System(FLO-TECH-TOR(FLO-TECH-TOR & UFOS & UFOS))

Same as FLO-TECH-TOR™ plusSame as FLO-TECH-TOR™ plus

Early and training ambulationEarly and training ambulation– When the time is rightWhen the time is right

– Usually 48 hours to 7 days after receipt of FLO-TECH-TOR™

Patient interactivePatient interactive

– Involve the patient in their rehabInvolve the patient in their rehab

One APOPPSOne APOPPS Three Prosthetic Programs:Three Prosthetic Programs:

#3, #3, The The Preparatory SystemPreparatory System(VCSPS™ & UFOS™)(VCSPS™ & UFOS™)

Independent ambulationIndependent ambulation– 2 weeks to 6 months post-op2 weeks to 6 months post-op

Expedite care:Expedite care:

The The APOPPS™APOPPS™

(FLO-TECH-TOR(FLO-TECH-TOR, VCSPS™ & UFOS™), VCSPS™ & UFOS™)

One APOPPS-TFOne APOPPS-TF Two Prosthetic Programs:Two Prosthetic Programs:

– #1, #1, The The FLO-TECH-TOR-TFFLO-TECH-TOR-TF

– Use as protective socket onlyUse as protective socket only Prevent scraping & impact Prevent scraping & impact

injuriesinjuries

Monitor progress with instant Monitor progress with instant access to bandagesaccess to bandages

Immediate, early or extended Immediate, early or extended wear protective socketwear protective socket

Especially good for revision Especially good for revision surgery and to prevent injurysurgery and to prevent injury

One APOPPS-TFOne APOPPS-TF Two Prosthetic Programs:Two Prosthetic Programs:

#2, #2, The The Preparatory SystemPreparatory System

(FLO-TECH-TOR-TF™ & UFOS-TF™)(FLO-TECH-TOR-TF™ & UFOS-TF™)

Early or training ambulationEarly or training ambulation

Extended or independent Extended or independent ambulation ambulation

– (2 weeks to 6 months post-op)(2 weeks to 6 months post-op)

Expedite care:Expedite care:

The The APOPPS-TF™APOPPS-TF™

(FLO-TECH-TOR-TF(FLO-TECH-TOR-TF & UFOS-TF™) & UFOS-TF™)

When should I use an When should I use an APOPPS™ or APOPPS-TF™APOPPS™ or APOPPS-TF™ All diagnoses & agesAll diagnoses & ages

In the ORIn the OR Early postoperativeEarly postoperative (24 to 48 hours post-op)(24 to 48 hours post-op)

1 to 3 weeks post-op (cast change)1 to 3 weeks post-op (cast change)

Any time protection or immediate, early Any time protection or immediate, early or sustained ambulation, is orderedor sustained ambulation, is ordered

Early Ambulation ProtocolEarly Ambulation Protocol

Patient selectionPatient selection– Competent, coherent & cooperative Competent, coherent & cooperative

except in ORexcept in OR

– Reasonable family or residence Reasonable family or residence supportsupport

– Reasonable upper body strengthReasonable upper body strength

Early Ambulation ProtocolEarly Ambulation Protocol

Apply FLO-TECH-TOR™ or FLO-TECH-TOR-TF™ Apply FLO-TECH-TOR™ or FLO-TECH-TOR-TF™ In OR or as soon as prescribedIn OR or as soon as prescribed

Examine residuum before attempting distal Examine residuum before attempting distal pressurepressure

Tighten all straps & bands before testing distal Tighten all straps & bands before testing distal tolerance or attempting weight bearingtolerance or attempting weight bearing

Apply pressure to distal end (up to 10% of body Apply pressure to distal end (up to 10% of body weight) to determine readiness for weight weight) to determine readiness for weight bearingbearing

Examine residuum after testing distal tolerance Examine residuum after testing distal tolerance Apply UFOS™ or UFOS-TF™ 48 hours to 7 days Apply UFOS™ or UFOS-TF™ 48 hours to 7 days

post application of FLO-TECH-TOR™ or FLO-post application of FLO-TECH-TOR™ or FLO-TECH-TOR-TF™ - when the time is right. TECH-TOR-TF™ - when the time is right.

Early Ambulation ProtocolEarly Ambulation Protocol Weight bearing at 10%Weight bearing at 10%

– Tighten straps and bands prior to standingTighten straps and bands prior to standing After weight bearing After weight bearing

– Examine tissue – check for spottingExamine tissue – check for spotting Excessive or continuous - contact physician, Excessive or continuous - contact physician,

minor:minor:– Record size & location and monitorRecord size & location and monitor

Wash and re-apply reticulated padWash and re-apply reticulated pad Replace outer sock if soiledReplace outer sock if soiled

– Reapply FLO-TECH-TOR™ or FLO-TECH-TOR-Reapply FLO-TECH-TOR™ or FLO-TECH-TOR-TF™TF™

MPT strap - 1 to 2 fingers looseMPT strap - 1 to 2 fingers loose

Early Ambulation ProtocolEarly Ambulation Protocol

Progress to 20% weight bearingProgress to 20% weight bearing– Only after 2 days without pain or Only after 2 days without pain or

spottingspotting

Repeat all above daily until patient Repeat all above daily until patient is full weight bearingis full weight bearing– Progress at 10% increments until Progress at 10% increments until

patient ambulates independently and patient ambulates independently and without incidentwithout incident

Practitioner SurveyPractitioner Survey In December 1998 SurveyIn December 1998 Survey

13 Practitioners responded on 94 patients13 Practitioners responded on 94 patients

– 1 Bilateral1 Bilateral

– 95 Transtibial amputation socket fittings 95 Transtibial amputation socket fittings

DiagnosesDiagnoses Diabetes Diabetes = = 5555 == 58.50%58.50%

PVD PVD = = 3232 == 34.05%34.05%

Trauma Trauma = = 5 5 == 5.32% 5.32%

Other Other = = 2 2 == 2.13% 2.13%

TOTAL TOTAL = = 9494 = 100.00%= 100.00%

ApplicationApplication Patient’s Room Patient’s Room 38 =38 = 40.00%40.00% Operating RoomOperating Room 1717 == 17.90%17.90% Rehab Dept./Center Rehab Dept./Center 1616 == 16.80%16.80% Nursing FacilityNursing Facility 9 9 == 9.47% 9.47% Recovery RoomRecovery Room 5 5 == 5.26% 5.26% Patients HomePatients Home 5 5 == 5.26% 5.26% ClinicClinic 3 3 == 3.16% 3.16% P&O FacilityP&O Facility 2 2 == 2.15% 2.15%

TOTAL SOCKETSTOTAL SOCKETS 9595 == 100.00%100.00%

How Was The APOPPS™ Used?How Was The APOPPS™ Used? 95 FLO-TECH-TOR95 FLO-TECH-TOR sockets reported sockets reported

– 54 (of 95) FLO-TECH-TOR54 (of 95) FLO-TECH-TOR Sockets Sockets

For protection onlyFor protection only 56.84%56.84%

– 41 (of 95) advanced to Rehab System41 (of 95) advanced to Rehab System

(FLO-TECH-TOR(FLO-TECH-TOR & UFOS & UFOS ) ) 43.16%43.16%

100.00%100.00%

– 19 Rehab advanced to Prep System19 Rehab advanced to Prep System

(VCSPS(VCSPS & UFOS & UFOS ))

19 of 41 – wearing 2 to 6 mos.)19 of 41 – wearing 2 to 6 mos.) 46.34%46.34%

COMMENTARYCOMMENTARY TheThe APOPPS™ APOPPS™ provides & preserves quality.provides & preserves quality.

It offers safe postoperative care (including It offers safe postoperative care (including

ambulation) for: diabetic, elderly, circulatory ambulation) for: diabetic, elderly, circulatory

dysfunction & traumatic amputees.dysfunction & traumatic amputees.

It allows prosthetists to adapt the prosthesis It allows prosthetists to adapt the prosthesis

to meet the rehabilitation needs of their to meet the rehabilitation needs of their

patient in a gentle, yet dynamic, and cost patient in a gentle, yet dynamic, and cost

effective manner.effective manner.